Obstetric–Neonatal Care during Birth and Postpartum in Symptomatic and Asymptomatic Women Infected with SARS-CoV-2: A Retrospective Multicenter Study

Data Availability Statement: Data are available upon reasonable request. All necessary data are supplied and available in the manuscript; however, the corresponding author will provide the dataset upon request. All data relevant to the study are included in the article.Copyright © 2022 by the authors. This study analyses the obstetric–neonatal outcomes of women in labour with symptomatic and asymptomatic COVID-19. A retrospective, multicenter, observational study was carried out between 1 March 2020 and 28 February 2021 in eight public hospitals in the Valencian community (Spain). The chi-squared test compared the obstetric–neonatal outcomes and general care for symptomatic and asymptomatic women. In total, 11,883 births were assisted in participating centers, with 10.9 per 1000 maternities (n = 130) infected with SARS-CoV-2. The 20.8% were symptomatic and had more complications both upon admission (p = 0.042) and during puerperium (p = 0.042), as well as transfer to the intensive care unit (ICU). The percentage of admission to the Neonatal Intensive Care Unit (NICU) was greater among offspring of symptomatic women compared to infants born of asymptomatic women (p < 0.001). Compared with asymptomatic women, those with symptoms underwent less labour companionship (p = 0.028), less early skin-to-skin contact (p = 0.029) and greater mother–infant separation (p = 0.005). The overall maternal mortality rate was 0.8%. No vertical transmission was recorded. In conclusion, symptomatic infected women are at increased risk of lack of labour companionship, mother–infant separation, and admission to the ICU, as well as to have preterm births and for NICU admissions.FISABIO grant number UGP-20-24

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Presumed solitary circumscribed retinal astrocytic proliferation: a lesion that can regress

V&iacute;ctor Manuel Asensio-S&aacute;nchezOphthalmology Department, Clinical University Hospital of Valladolid, Valladolid, SpainAbstract: A 56-year-old woman had an yellow-white retinal lesion superior to the optic disc. Optical coherence tomography demonstrated the mass with a snowball configuration and smooth surface. Autofluorescence disclosed revealed moderate hypoautofluorescence. Ultrasonography showed no calcification. Visual field examination showed an enlargement of the blind spot corresponding to the predominantly superotemporal juxtapapillary extension of the lesion. Eight months later, the lesion spontaneously resolved. Presumed solitary circumscribed retinal astrocytic proliferation (PSCRAP) is a benign stable retinal tumor, but PSCRAP has been reported to resolve spontaneously here. It differs from other white or yellow-white lesions of the retina in important ways that enable the ophthalmologist to reassure the patient as to its benign prognosis.Keywords: presumed solitary circumscribed retinal astrocytic proliferation, benign lesion, astrocytes, acquired retinal astrocytoma, astrocytic hamartoma, spontaneous regres

Progressive loss of vision caused by asymptomatic pituitary macroadenoma: role of OCT

V&iacute;ctor Manuel Asensio-S&aacute;nchez,&nbsp;Javier Foncubierta Ophthalmology Department, Clinical University Hospital of Valladolid, Valladolid, Spain Introduction: Most pituitary adenomas are clinically inactive. In patients with long-standing compression of the optic chiasm, ganglion cells may undergo axonal degeneration. Spectral domain optical coherence tomography (SD-OCT) is able to identify retinal nerve fiber layer (RNFL) and ganglion cell loss in the retina. We present a case in which SD-OCT was used to diagnose an asymptomatic pituitary macroadenoma.Clinical case: A 48-year-old female presented with progressive vision loss in both eyes. SD-OCT identified atrophy of the ganglion cell and nerve layers, with preservation of outer layers bilaterally. Magnetic resonance imaging of the brain showed a pituitary macroadenoma. The pathological diagnosis was nonfunctioning adenoma.Discussion: As macroadenomas enlarge, they can induce uncrossed axon loss, resulting in nasal field defects and reduced visual acuity. In these cases, there is atrophy of the nasal and temporal portions of the optic disc, thus occupying a horizontal band across the disc. SD-OCT is able to identify RNFL loss in eyes with band atrophy of the optic nerve, which correlates with visual field defects found in perimetry. SD-OCT is a useful tool to assess the structural and functional damage of ganglion cells. In our case the SD-OCT demonstrated a symmetrical loss of the RNFL and the ganglion cell layer in both eyes, indicating important optic nerve damage. Keywords: OCT, pituitary, adenoma, RNFL, ganglion cell laye

Multiple retinal hemorrhages in bilateral congenital venous tortuosity

V&iacute;ctor Manuel Asensio-S&aacute;nchez,&nbsp;Mar&iacute;a Soledad Rubio-Mart&iacute;nez,&nbsp;Alba Mart&iacute;n-Prieto Ophthalmology Department, Clinical University Hospital of Valladolid, Valladolid, Spain Abstract: We present a case of a previously healthy 52-year-old woman with acute onset of scotomas in both eyes. It was associated with headache and vomiting for the past 1 week after a cold. The best-corrected visual acuity was 20/20 in both eyes. The examination of bilateral fundus revealed a venous tortuosity and mild dilatation in the posterior pole, with pre- and intraretinal hemorrhages. However, vasculatures were normally straight in the mid-peripheral and peripheral retina of both eyes. Hemorrhages showed complete resolution without treatment. There was no change in the appearance and shape of the vasculature. Ophthalmologists should be aware of congenital venous tortuosity as a possible cause of retinal hemorrhages. Keywords: venular tortuosity, retinal vascular tortuosity, unexplained retinal hemorrhages, recurrent retinal hemorrhage

Photoleukocoria with smartphone photographs

V&iacute;ctor Manuel Asensio-S&aacute;nchez, Luc&iacute;a D&iacute;az-Cabanas, Alba Mart&iacute;n-Prieto Ophthalmology Department, Clinical University Hospital of Valladolid, Valladolid, Spain Abstract: A 3-year-old boy was referred with suspected leukocoria in the right eye, detected in all smartphone photographs taken by his parents. His medical and family history was unremarkable. The visual acuity was 20/20 in both eyes. Eye examination revealed full motility and normal pupils. The ocular fundi and ultrasonography appeared normal. The child was looking to the left side in his photographs, away from the camera, and illuminating the nasal retina. In this circumstance, the optic nerve head acts as a diffuse reflector, reflecting the light out of the eye through the pupil. In the case of normal clinical findings in a child presenting leukocoria in smartphone photographs (photoleukocoria), the ophthalmologist should suspect the possibility of the described phenomenon avoiding other studies. Keywords: leukocoria, eye manifestations, white pupil, normal examination, reflex, false negative refle

Unusual extraconal orbital location of a cavernous hemangioma

Cavernous hemangioma is the most common benign orbital and vascular tumor in adults. It is mostly located intraconally. Nevertheless, when the location is extraconal, the displacement of the globe is opposite the tumor's position. We describe an unusual presentation of this tumor in a 75-year-old female. The only symptom was the presence of epiphora. In the clinical examination, a mass was palpated on the lower orbital rim of the right eye. The magnetic resonance imaging (MRI) showed a well-circumscribed ovoid mass with a strong T2 hyperintensity and progressive contrast filling in T1. Excisional biopsy was performed, which confirmed the diagnosis of cavernous hemangioma. At five months of follow-up, there was no evidence of new symptoms